Association of markers of hemostasis with death in HIV-infected women

J Acquir Immune Defic Syndr. 2014 Nov 1;67(3):287-94. doi: 10.1097/QAI.0000000000000306.

Abstract

: In HIV negatives, markers of hemostasis, including D-dimer, factor VIII, plasminogen activator inhibitor-1 antigen (PAI-1), and total protein S are associated with all-cause and cardiovascular disease mortality. In HIV positives, studies of D-dimer and factor VIII with death were limited to short follow-up; associations of PAI-1 and total protein S with death have not been examined. In 674 HIV-infected women from the Women's Interagency HIV Study, markers from the first visit after enrollment were exposures of interest in multivariate analyses of death (AIDS and non-AIDS) in separate models at 5 and 16 years. There were 87 AIDS and 44 non-AIDS deaths at 5 years, and 159 AIDS and 113 non-AIDS deaths at 16 years. An inverse association of total protein S quartiles with non-AIDS deaths was observed at 5 (P trend = 0.002) and 16 years (P trend = 0.02); there was no association with AIDS deaths. The third quartile of PAI-1 was associated with AIDS deaths at 5 [hazard ratio (HR) = 4.0; 95% confidence interval (CI): 1.9 to 8.4] and 16 years (HR = 3.4; 95% CI: 1.9 to 5.9); and with non-AIDS deaths at 5 years (HR = 4.8; 95% CI: 1.6 to 13.9). D-dimer and factor VIII were not associated with AIDS or non-AIDS death at 5 or 16 years. Lower total Protein S was a consistent marker of non-AIDS death. We found no association between D-dimer with AIDS or non-AIDS death, in contrast to previous studies showing increased short-term (<5 years) mortality, which may represent sex differences or population heterogeneity. Given longer survival on highly active antiretroviral therapy, further studies of these markers are needed to determine their prognostic value.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Biomarkers / blood
  • Factor VIII / analysis
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • HIV Infections / blood
  • HIV Infections / mortality*
  • Hemostasis / physiology*
  • Humans
  • Middle Aged
  • Multivariate Analysis
  • Plasminogen Activator Inhibitor 1 / blood
  • Predictive Value of Tests
  • Prospective Studies
  • Protein S / analysis
  • United States / epidemiology

Substances

  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • Plasminogen Activator Inhibitor 1
  • Protein S
  • fibrin fragment D
  • Factor VIII